2007年-世界发展银行全球_Output-Based_Aid_in_Health___The_Argentine_Maternal-Child_Health_Insurance_Program_4页_420kb

OBA Approaches 39608: Summary of the Argentine Maternal-Child Health Insurance Program

Core Content

The Argentine Maternal-Child Health Insurance Program, known as Plan Nacer, was introduced in 2004 by the Argentine government and the World Bank to address the rising infant mortality and health disparities in the poorest provinces of Argentina. The program uses an output-based aid (OBA) approach to ensure that health services are delivered efficiently and effectively to the most vulnerable populations.

Main Objectives

• Improve access to basic maternal and child health services for the poor.
• Reduce infant and maternal mortality through targeted interventions.
• Address the inefficiencies and inequities of the existing health system, which was heavily biased towards formal employment and lacked coverage for the informal sector.

Key Features of the Program

• Targeted Subsidies: Focuses on the poorest provinces and populations, particularly pregnant women and children under six.
• Output-Based Funding: Provincial governments receive funding based on the number of enrolled beneficiaries and performance on specific health indicators ("tracers").
• Decentralized Management: Each province has a health service purchasing unit responsible for enrollment and awareness campaigns.
• Independent Service Providers: Health services are contracted from both public and private providers, who are reimbursed for each service provided.
• Quality Incentives: Providers are incentivized to deliver high-quality care through performance-based tracers and regular audits.
• Risk Sharing: Provincial governments and service providers share financial risks, with the former managing enrollment and marketing, and the latter managing service delivery and operational costs.

Implementation Mechanism

• The program is implemented through annual performance agreements between the national and provincial governments.
• Tracers are a set of 10 indicators measuring both output (e.g., number of vaccinations) and outcome (e.g., newborn weight, Apgar scores).
• Payments are made in two parts: 60% based on enrollment and 40% based on performance on the tracers.
• Independent third-party auditors verify performance targets before funds are released.

Service Pricing and Provision

• Capitation-based payments are used, similar to insurance premiums, with unit prices determined by cost analysis and benchmarking.
• Service providers are reimbursed per intervention, not per visit, and must provide medical records for auditing.
• The program allows for flexibility in service delivery, as providers can choose how to offer services as long as they meet quality standards.

Results and Impact

• By March 2006, 369,559 people had been enrolled—45% of the eligible population and exceeding the initial target.
• The program demonstrated promising results, leading to the approval of an additional $1.7 million World Bank loan to expand to 15 more provinces.
• The success of the program highlights the effectiveness of combining output-based contracting with output-based funding in improving health outcomes.

Conclusion

• The program successfully combines quantity and quality incentives to improve health service delivery.
• It enhances accountability and efficiency by transferring risks to service providers and purchasing units.
• The decentralized and transparent management model allows for better adaptation to local needs and improved targeting of subsidies.
• The market-based approach encourages competition and innovation among service providers, leading to better health outcomes for the poor.

References

• Argentina, Provincial Maternal-Child Health Investment Project (1st phase APL) P071025. World Bank.
• Di Tella, Rafael, and William D. Savedoff, eds. 2001. Diagnosis Corruption: Fraud in Latin America's Public Hospitals. Washington, D.C.: Inter-American Development Bank.
• World Bank. 2005. A Guide to Competitive Vouchers in Health. Washington, D.C.: World Bank.

About OBA Approaches

OBA Approaches is a series that discusses innovative methods for delivering basic services to the poor in developing countries. It highlights the use of output or performance-based approaches in sectors like health, education, and infrastructure. The case studies are selected by the authors in consultation with the GPOBA management team and are not affiliated with donors or any other organization.